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SWRCB, January 2002 <br />Page of <br />Secondary Containment Testing Report Form, <br />This form is intended for use by contractors performing periodic testing of UST secondary or submittal to the local regulatory containment systems. lato Use the <br />appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and <br />printouts from tests (if applicable), should be provided to the facility ownerlop a f .� ry $ en <br />cy. <br />1. FACILITY INFORMATION <br />Facility Name: Estes — Stockton Terminal <br />Facility Address: 7611 S. Airport Way Date of <br />Facility Contact: <br />Date Local Agency Was Notified of Testing: Phone: <br />Name of Local Agency Inspector (if present during testinvl <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name. JP Petroleum Service <br />Technician Conducting Test: John Puumala <br />Credentials: x CSLB Licensed Contractor <br />❑ SWRCB Licensed Tank Tester <br />License Type: A License Number: 81 1471 1 C # 5252406 <br />Manufacturer <br />Manufacturer Training <br />Components} <br />9/2/14 <br />Date Traini <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />YY MCI W US <br />and returned to <br />tank. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signat <br />